Perfusion-Uk最新文献

Hereditary spherocytosis (HS) is a rare inherited haemolytic anaemia. This case report outlines a neonatal patient with presumed HS requiring cardiopulmonary bypass (CPB) and the whole blood exchange transfusion carried out in the immediate pre bypass setting to ensure a successful outcome.

BackgroundCardiac surgery is associated with increased risk of major adverse outcomes. Venous to arterial carbon dioxide tension gap (Pv-aCO₂ gap) showed significant prognostic value of non-cardiac surgery, while their prognostic value after cardiopulmonary bypass (CPB) remains controversial.MethodsWe conducted a systematic research of PubMed, MEDLINE, EMBASE and Web of science electronic database and ClinicalTrials.gov to analysis the association between high Pv-aCO₂ gap and adverse outcomes in adult cardiac surgery patients. Random effect model was used to pool data.ResultsEight studies (n = 2136 patients) were enrolled. High Pv-aCO₂ gap was mainly defined as Pv-aCO₂ ≥ 6-8 mmHg. In cardiac surgery, high Pv-aCO₂ gap was not associated with increased hospital mortality (odds ratio, 0.63; 95% CI, 0.17-2.32; p = 0.49)), but was related with higher ICU mortality (odds ratio, 5.27; 95% CI, 2.31-12.00; p < 0.001), higher incidence of major complications (p < 0.05), longer ICU length of stay (p = 0.03) and prolonged ventilation time in the ICU (p < 0.001). Moreover, high Pv-aCO₂ gap was linked to postoperative lower cardiac index (p < 0.01) and lower ScvO₂ (p < 0.001). Interesting, high Pv-aCO₂ gap was not associated with increased postoperative lactate level and longer hospital length of stay.ConclusionAn elevated Pv-aCO₂ gap seems to be associated with adverse outcomes in very short time and indicates tissue hypoperfusion rather than tissue hypoxia. Therefore, interventions aiming at normalizing Pv-aCO₂ gap may potentially improve clinical outcomes, while further validation is required.

ObjectiveThe study objective was to describe our experience of performing the relatively simple technique of crescent plication of one or more sinus of Valsalva in various clinical scenarios as an alternative to root replacement and to assess the mid to long term results.MethodsFrom 2006 to 2016 17 patients underwent crescent plication of one or more aortic sinuses in association with other procedures 12 had trileaflet aortic valve (group one) four had bicuspid aortic valve (group two) in addition there was a single patient with Marfan syndrome who presented with acute type A aortic dissection.ResultsCrescent plication resulted in a moderate reduction in root diameter that has remained stable over the study period apart from the Marfan patient who unsurprisingly showed modest root dilation over time.ConclusionsCrescent plication is a relatively simple procedure that reduced root diameter and appears to be stable over time in all but the syndromic patient and can be a viable alternative in situations where full root replacement is judged hazardous.

This case report discusses the management of a 15-year-old Jehovah's Witness (JW) with DiGeorge syndrome, complex congenital heart disease (CHD), and severe neuromuscular scoliosis requiring major orthopedic surgery. Refusal of blood transfusions required preoperative optimization and advanced blood conservation strategies. The patient underwent multiple cardiac surgeries and spinal fusion. This case emphasizes multidisciplinary coordination and blood management strategies for surgical cases with religious restrictions.

IntroductionThe objective of this study was to establish a rat model for cardiopulmonary bypass (CPB) with cardiac arrest and resuscitation and to investigate the regulatory role of HTK solution in protecting cardiomyocytes against oxidative stress by upregulating Nrf2.Methods40 rats were randomly assigned to four groups: the control (Ctrl), the histidine-tryptophan-ketoglutarate (HTK), 4:1 blood cardioplegia (BC) and del Nido cardioplegia (DN) groups. The cardiopulmonary bypass (CPB) procedure was implemented and sustained for a duration of 1 hour. Subsequent to the cessation of CPB, the rats were subjected to monitoring and observation for an additional 2 hours. Following this observation period, the heart and blood samples were procured for subsequent analysis.ResultsThe MDA was significantly higher in the HTK group, BC group, and DN group compared to the Ctrl group. The HTK group had lower MDA levels than the BC group. Regarding MPO activity, it increased in the HTK group, BC group, and DN group relative to the Ctrl group. Both the BC and DN groups exhibited elevated MPO levels compared to the HTK group. SOD levels were significantly lower in the HTK, BC, and DN groups compared to the Ctrl group. The HTK group had higher SOD levels than the BC group. With respect to miRNA-210-3P and Nrf2, the expression were more efficient in the HTK, BC, and DN groups compared to the Ctrl group. The BC and DN groups showed reduced expression efficiency over the HTK group. Western blot analysis indicated that the ratio of Nrf2 target was higher in the HTK group, BC group, and DN group in comparison to the Ctrl group. Both the BC and DN groups had lower protein content compared to the HTK group. Immunohistochemistry scoring of HIF1-α and nuclear Nrf2 revealed higher scores in the HTK, BC, and DN groups compared to the Ctrl group. The HTK group achieved higher scores than both the BC and DN groups.ConclusionVaried degrees of oxidative stress damage were exhibited by three distinct cardioplegia solutions. The HTK group demonstrated a superior antioxidant effect. The protective response of the HTK solution against oxidative stress may be linked to the up-regulation of Nrf2.

IntroductionManagement of neonatal Group B Streptococcal (GBS) sepsis with multi-organ failure requires innovative approaches when conventional therapies prove insufficient.Case ReportA term neonate developed severe respiratory failure and septic shock from GBS infection, necessitating veno-arterial extracorporeal membrane oxygenation (V-A ECMO) initiation at 24 hours of life. During ECMO support, the patient developed hepatic dysfunction with severe hyperbilirubinemia (peak total/direct bilirubin: 36.9/31.6 mg/dL). A Jafron HA60 hemoadsorption cartridge was integrated into the ECMO circuit, resulting in a 38% bilirubin reduction within 24 hours. Despite complications including lung atelectasis, renal dysfunction, and nosocomial COVID-19, the patient was successfully decannulated after 15 days, extubated after 24 days, and discharged home after 48 days with normal neurological outcomes.DiscussionThis case highlights the application of hemoadsorption technology for managing hepatic failure in neonatal ECMO.ConclusionHemoadsorption therapy represents a promising adjunctive treatment for neonates with severe hyperbilirubinemia during ECMO support.

IntroductionThis retrospective study investigated the relationship between differing thresholds of Conventional Ultrafiltration (CUF) and postoperative hemoglobin (HGB) in cardiac surgery cases involving cardiopulmonary bypass.MethodsThe study utilized EPIC and STS data for patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). It included three groups: those without CUF (n = 106), low CUF (volume <20 mL/kg; n = 33), and high CUF (volume ≥20 mL/kg); n = 18). HGB levels were assessed at the following points: Pre-operative, end-bypass, first hour in the ICU, discharge, and 30 days post-procedure. Total intravenous fluid administration at 72 hours postoperatively was also evaluated.ResultsThere was no significant difference between the three groups in HGB pre-operatively, end-bypass, or during the first hour in the ICU. At discharge, the non-CUF group had significantly higher HGB levels than the high CUF group (p = 0.028), and HGB in the low CUF group was not significantly different from the high CUF (p = 0.102) group. At 30 days, HGB in the low CUF group was significantly higher than those with high CUF (p = 0.022). Additionally, HGB levels in the non-CUF group were not significantly different than those with high CUF (0.078). Surprisingly, there was no difference in total IV fluid volume administered at 72 hours post-op (p = 0.181) between any of the groups.ConclusionsLow CUF is superior to no CUF, and high CUF in the preservation of hemoglobin levels - even at 30 days. Additionally, CUF of any volume was not associated with increased IV fluid resuscitation postoperatively.

The success of extracorporeal membrane oxygenation (ECMO) in treating Systemic Lupus Erythematosus (SLE) and the risk factors associated with mortality remain uncertain. Methods: We describe the survival outcomes at discharge of the largest SLE cohort on ECMO support. We performed a retrospective cohort study of the Extracorporeal Life Support Organization registry database from 2012 to 2022. Pediatric and adult survivor groups were analyzed using descriptive statistics for the primary study outcome of survival to hospital discharge. Risk predictors for survival were determined by logistic regression.Results: We included 48 children and 368 adults with SLE. Overall, 198 patients (54%) survived to hospital discharge, with a survival of 52% and 47% of pediatric and adult patients, respectively.Conclusion: We conclude that ECMO can be considered a life supporting strategy in pediatric and adult SLE patients.